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PERMIT APPLICATION <br /> 0111PBUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> *14 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> Wiser r Black I kOni ;Please). , - PROJECT SITE INFORMATION .. <br /> PROJECT SITE ADDRESS:,1199 lad )C €(,j „„dri_ %261 PROPERTY TAX#: 9SO 'ION()2;3-00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT i[NFORIOT ION <br /> OWNER NAME: 11 1 d i tek 00 As QX1-J TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET jjjI 'u(4'H^ F( S14) <br /> CITY i,ntA STATE kiji- ZIP 9 <br /> OWNER PHONE: (L{ec 3 f2 `� )°a- OWNER EMAIL: f P hOu.S['lr I/1 (�! IYY1C Cfbt•1/1 <br /> CONTRACTOR NAME: K?!(q 5 'f•�Qfj y1 q I(�l C_ <br /> CONTRACTOR ADDRESS: tJ STREET lf8 (J I g39) \/ <br /> CITY W niAZOCI STATE LOA- ZIP 98(J <br /> CONTRACTOR PHONE: (L J) CONTRACTOR EMAIL: YY1 idelafI -e @ Kt&j'ke0. •Cdvp <br /> CONTRACTOR LICENSE#(REQUIRED): 1 kiCA1 l tY-11-V CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: gOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACTNAME: CONTACT PHONE: Cic' 3J(�—/ )2.13- <br /> I`i V.- & ?1(\ov l,5CONTACT EMAIL: (P h oas Cc v...‘(G�/\G:'met cign, <br /> BUII WHts,:I 1 RM T APPL1 AeiTIO ` . <br /> Existing Use of Building: 1114./i 4 l Contract Price of Work:$ �i � <br /> Proposed Use of Building: Heat Source: 'Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached pitsFR-Attached El Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel aIRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 9\-ef i o 1� �� toCtkir Ung ' axirod,c_ 1-4,e F ( 1111--e.. <br /> ASSOCIATE BD UIL WNG PERMIT# applicable):if <br /> ( <br /> MECHANICAL:.PERMIT APPLICATION ' PLUMBING=PERMIT APP ,ICA11ON <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: New Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> ( Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER i SUPPRESSION SYSTEM '..; <br /> Chemical or Water I INo.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before.-ing authorized under any - umstance.I am the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the ate • .ct Law 18. RC .nd 296. OA WAC. <br /> City of Everett Official Use Only <br /> PERMIT <br /> Ie?4, 14e ry) V�rV <br /> Owner/Authorized Age•t Si ature Date (Revised 9/23/2016) <br />